Reflections on Life, Being Human, and Medicine Archives - Page 47 of 51

In the end of my post on burnout, I asked for your input. Based on that I feel compelled to write once more. This is a longer post but please bear with me. I think you will find something of value in it for you.

As a result of the first post on burnout, the vast majority did what I had really hoped you would do.

Recognized the burnout or tendencies toward burnout in yourself. (Everyone has this, by the way.)
Thought about what can or should be done within your life.
Banded together as “brothers” in the battle.

Some of you were deeply concerned for me. This was very nice but made me want to reassure you. I am far less worried about me than I am about my friends and colleagues.

I am the one who has been given a forced sabbatical. I am the one who has had such fatigue from my surgery and treatments that I have been forced to sleep. In fact, I have slept more recently than I have been able to sleep in years. This period on short term disability is the longest period that I have not worked in my entire adolescent or adult life.

I am also the one whose mind has been reopened and regained the ability to think and write. This blog is what happens when you let Mike have a little too much free time! J

What my post did (several thousand views), was to open up and expose a wound.

Like a surgical debridement, it seemed to expose the raw but living tissue under some layers of scar. And like a surgeon, once I cut down and could see the raw granulation tissue it made me happy. There is healthy and living tissue underneath.The pain that you feel and the longing to live a full and rich life is a sign of health. It is the essence of you that remains. Deep down you are there. You are very much alive.

For the non-medical, what does this talk of debridement mean?

Sometimes when someone has a wound, devitalized tissue (scar tissue or dead tissue) can form over the wound. The scar tissue blocks oxygen from the wound. It can make it hard or even impossible for the wound to heal. In those cases, a surgeon has to do a debridement. This is when they use a scalpel and cut into the tissue. They carefully peel back layers of tissue that are no longer alive to get to the tissue that is still vital and alive. The layers the surgeon remove might seem as though they are providing a covering or protection to the wound. But in reality, they are just hurting the healthy tissue and preventing it from healing.

That was my intention of the post. By openly sharing my pain and struggle, I hoped to open up your wounds as well.

And now that the surgeon has opened the wound we must proceed with the next step. We must protect the wound and see if we can truly help it to heal.

This makes me nervous. In terms of burnout, I am better, but I am living not in reality and I do not yet know that I am cured. I do not know if I am yet competent to apply the salve or the sterile dressing that could best help with the healing. I am empowered by dozens of comments and messages. I feel an obligation to attempt the wound dressing because I was part of cutting the wound open again. I also feel an obligation to tabulate or collect the wisdom that was shared with me and reflect it back to you.

Image result for salve on a wound — https://www.wikihow.com/images/thumb/d/df/Treat-Deep-Cuts-Step-7-Version-2.jpg/aid9471077-v4-728px-Treat-Deep-Cuts-Step-7-Version-2.jpg

What are the next steps?

How can everyone go forward with sustainability and joy and balance and without guilt?

Pray for wisdom.That is the very first step. Pray for wisdom to live the life that you ought to live. Do not just live the life that others tell you to live. Live the life that the Lord has intended you to live. What is your role in this life? Do you have a vocation (a calling)? What is your drive and desire? What is your role in this life and how can you do that in a full and rich way?

Passion:Indulge in passion. I have learned over and over again that experiences that you do fully are much better than those that you try to minimize.

As a teen I had the job of driving the forklift forward to catch the cherries off of the cherry shaker (harvester). Honestly, it could be a dull job. Drive forward. Wait. Drive backward. Wait. Repeat. Do that a LOT of times over and over and over and over again.

This job however became much better when I pretended to be the best cherry tank forklift driver ever! Could I get the tank in place as soon as possible? Could I pull in perfectly each time? What would the world’s greatest cherry tank driver do? That I was going to aspire to. And suddenly the job got much better.

For whatever you do, please do not shrink away. Own it and dominate it. Seek passion within yourself and exert that passion. If you have to deal with difficult patients or difficult situations ask yourself, “What would an expert in this situation do? How would the BEST person handle this? Can I become the expert? Can I be the BEST!”

Live:Do not be afraid to live. Do not feel guilty to live. As I have said repeatedly and as was sent back to me in so many different messages and ways – live.

What does this mean? It means feel, taste, smell, see, and hear what you are experiencing right now. Stop at least 5 times a day to just live. Stop yourself and take in the world with all of your senses. Like you might do if you felt it was your last chance to do so. Or do it as if you were allowed to come back from the future to get to relive an experience one more time. Truly experience it.

In this moment I feel the chill in the air. I see the pale light of the one click on the 3-way light and the empty shelves my wife made last night in her work to redecorate for Christmas. (I wrote this in the decorating gap between Thanksgiving and Christmas.) I smell little but the familiar smell of our home. I hear the clock in the background and the sigh of our beagle, Malley. Ok – I don’t taste much – which reminds me that I could go get a cup of coffee! But nonetheless – these past 10 seconds were rich. They made me love this moment. This time at 5:10 am when I am awake and not able to sleep, I now love. As a future time-traveler coming back to this moment I would relish in these familiar 5 sense experiences of my present home. Why then should I not similarly enjoy them now?

Look across the table at your spouse or your children. Look at the beauty in their eyes. Look at their supple skin. Look at the curve of their mouth when they smile. Indulge in it. Smell the food. Savor the taste as you put the food in your mouth. Hear the giggles or the beautiful tone of their voices. Reach out and touch them. Feel their silky hair or the soft skin of their hand. Perhaps the hand is older and wrinkled. Enjoy how you have gained those wrinkles together. Recall the first moments you held hands and when the hand was clammy with nervousness. Smile inside as you richly drink in this full experience.

Decide that you are going to remove the blinders and force yourself to stop at least 5 times a day to just LIVE.

There will never be enough time. Can you be so brave to live in the time that you have?

Seek treatment more than a cure:This is a hard but important lesson. In patients with chronic pain we are taught that if they seek to be pain-free they will never get better. If they seek to be pain free, the psychological focus shifts onto their pain and it begins to dominate their lives even more. Instead, we are to ask them to focus on living their lives.

The focus of treatment is to be able to do more and more. The focus must be to regain functional capacity rather than to be pain free.

So also, must we do with our burnout. The harsh reality is that this world is a fallen and broken world.

The Bible tells us, “Cursed is the ground because of you; through painful toil you will eat food from it all the days of your life. It will produce thorns and thistles for you, and you will eat the plants of the field. By the sweat of your brow, you will eat your food…”^[1]

I don’t mean to not be cheery but whatever job you do, it eventually will become work. Your goal is not to escape toil for it is not possible. Your goal is to seek a better life within it. I cannot fully make your pain go away. I cannot relieve you of work. I cannot at this moment take away the electronic health record (EHR.) I cannot make call nights go away. But I can encourage you to enjoy your life nonetheless. Focus on living better. Accept that some pain and toil are a part of what it means to be human. But please don’t let them dominate your mind or your life. Do not drive yourself crazy by trying to be pain free. Do not seek a perfect life. It does not exist. Seek to live a good life amidst the toil and pain and brokenness. This is indeed possible.

Celebrate:Celebrate the good that you have done. Do not brush away the successes. Relish them. Keep them in front of you as reminders. There are always good things that you have been a part of. Without guilt, indulge in experiencing them. Perhaps it is the patient who you really helped, or the project that was finally completed. Save a memento or some icon that will help you to remember it.^[2]Say to yourself, “This! This is why I do what I do!”

Band of brothers: From the Shakespearean play Henry V:

“We few, we happy few, we band of brothers; For he to-day that sheds his blood with me; Shall be my brother; be he ne’er so vile, This day shall gentle his condition; And gentlemen in England now-a-bed Shall think themselves accursed they were not here, And hold their manhoods cheap whiles any speaks, That fought with us upon Saint Crispin’s day.”^[3]

Image result for henry v st crispin's day speech — https://i.vimeocdn.com/video/634683697_1280x720.jpg

Do NOT – I repeat – Do NOT – do this alone. We can and must band together as a happy band of brothers (and sisters). You must have friends at work. Indulge in their presence. Indulge together in the challenges and thereby the glories in which you work. Think and fight together to make things better. Celebrate the ways that you stand up under the pressure together. Do not seek to run and hide but seek to stand up together under the strain and know that there is glory in that for you and them.

Within our advanced heart failure section, my favorite meeting is the early morning meeting that we have once a month when we meet at a coffee shop. It is generally without an agenda but is mostly a chance for us to gather as a “band of brothers and sister.^[4]” This has power because we are in it all together.

Honestly, Henry V is one of my favorite Shakespearean plays purely because of this scene. Get the movie and watch it or search out the St Crispin’s Day speech on YouTube. Go ahead and do it now. Turn the sound up. Stand up as you listen. The scene gives me chills and inspires me. Even now I feel stronger just thinking of it! Perhaps you should bookmark it on your web browser and then in times of struggle, pull it up with your colleagues and play it before you charge off to work!

Change jobs or retire:This is what some of you have done. Most are not able to do this. I am never one to recommend running away from your problems but for some this is the best solution. Only you can tell if this is the correct path for you. But for those who do not do this – please – do not just wait to retire. Please live your lives today. You cannot get yesterday back. Live today so that you can celebrate the yesterday in which you just lived.

Burnout is an epidemic. There are some things that are a huge part of the cause. I do not mean to lament the burden of charting in an electronic health record but this is one large factor. We must seek to fight to improve this. It will not go away but we must constantly fight against the current state.

And I hope the few suggestions above will provide some benefit to you?

There is one other solution, but I do not recommend it. It has something to do with getting diagnosed with cancer, a laparotomy, radiation and chemo and several weeks off of work. It does work. But I think the ideas from my prior post plus your collective ideas in items 1-7 above are more desirable than that!

To my own band of brothers (and sisters): I miss you! I hope to soon rejoin the battle. Please know that you have my respect and appreciation. You few. You happy few!

^[1]Genesis 3:17-19 (NIV)

^[2]Please see my LinkedIn post, “Nice Shoes”. Those shoes are an important icon to me to remind me to celebrate my career. https://www.linkedin.com/pulse/nice-shoes-michael-dickinson/

^[3]St. Crispin’s Day speech, Henry V, William Shakespeare, 1599

^[4]We love you Milena! We need more sisters like you with us in cardiology and AHF!

”While they were there, the time came for the baby to be born, and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no guest room available for them.”

In this Christmas holiday season we often read or hear read the story of the nativity. It is a grand and humble story. It warms our hearts. In this season of the nativity, I hope you will enjoy a reflection on my thinking on life.

As is usual in this blog, I honestly and openly reflect my thinking. Not everyone will agree with me. That is ok. But there is richness in the dialogue and how we all can learn from each other. These are the thoughts that fill my heart and mind this holiday season.

I enjoy a good novel.

In it there are of course some important elements. The characters and how they are developed is very important. They can’t be one dimensional. They must have some complexity. The narrative must flow well.

But above all there must be a plot. The plot cannot be too obvious. It has to develop and flow over time. It weaves in and out of the characters lives and we go on a journey of discovery as we read. If it is too obvious we will lose interest in the book. If there is no plot we end up wholly unsatisfied. But the masterful book is one in which we wonder what is going on. We are eager to find some purpose or meaning and how things can or might tie in.

The most excellent novels have elements that you see but perhaps don’t even really notice and then later they tie in with remarkable and profound meaning. They hit you and you are suddenly amazed at their significance. It all starts folding together and it makes sense. The pages that have gone before this point become cherished friends. You love them and are so glad you got to know them because now you know how important and how significant they were to what was really going on the whole time.

I like to think my life has been a great novel. It thrills me to see events that at the time didn’t seem to mean a lot and how they have come back years later to be of profound significance. There were thrilling times. There were slower times that were spent on developing the main character in the novel. But now I see how important those times were and even the mundane parts of the story now jump out as being ever so important.

Why does this matter?

What is reality? Are our lives meaningful? Are they the product of a skilled author who profoundly knows in advance what elements must be weaved in and out of our lives? Is our story being created for us? Will we be able to look back and read through it and appreciate it? Will we even love some of the passages for how profound they may seem in retrospect?

Or are our lives just happenstance? Do we stumble along doing the best that we can as we scribble on the pad of paper kind of inventing things as we go? Is it like the game where each person adds a line onto the story as we go around the room. These stories can be funny as each person goes up and down different tangents. But these stories are not elegant. They usually leave you unsatisfied. They are like a sweet that you munch on. It may taste good for awhile but doesn’t really leave you satisfied. They are not the full meal with all of its content that leaves you satisfied and happy at the end.

I have strong beliefs in this regard. There is no question in my mind which is reality.

I have seen it played out already. The story has been well written so far. It has so much more depth to the story than I would have added if I had written it myself. I think I would have written an obvious story without the subtleties that I now see and appreciate. I probably would have left out some things unless it made me look better or more dramatic. But mostly – I just would have written a much more dry and direct story.

The beginnings were humble. The plotline took time to develop. The first portion spent a lot of time developing the many characters and personalities. There were a lot of mundane details that I didn’t really appreciate at the time. But now I see how much color and realism and depth they added to the story. In retrospect I wouldn’t change them. I also love to go back and reread some of the parts. Some of the parts are painful. I reread them because I need to. They are important. Some are fun or funny. I tend to skip over some of the more embarrassing parts. I probably would love to cut those pages out but the author felt that they were necessary.

What am I trying to say?

There is purpose and meaning to all of our lives. It is startling and amazing and beautiful. It is more than what you could even imagine. I honestly believe that one of the joys of heaven will be to look back and see the incredible meaning behind it all. Like the sweet taste when you read the last page of a treasured book will be the joy of realizing that God was in charge the entire time. In spite of the difficult or stubborn characters in the book He was able to carry through an amazing story and weave it all together.

God is there. He is the author. He dreamed up who you would be, was there when you were conceived and was there as you grew in your mother’s womb. Your birth was not a surprise to Him. He has loved you before you could even know what love was. He was watching and cheering for you when you made good choices and perhaps wincing a bit as you made bad choices. He was pulling things together and calling to you with the goal that you would come to Him so that He could heal you and perfect you. You are His creation. You were made by Him and for Him and so that you could enjoy Him and He could enjoy you.

“God loves you and has a wonderful plan for your life.” This is one of the 4 spiritual laws that were popular in the 70s. It was an appeal to help people realize that He is a loving and personal God.

Please do not misunderstand. The story that He is writing for your – or His “wonderful plan” – is not a simple one. It is not a perfect plan because you and the whole world are part of a fallen creation. It is part tragedy. It is drama. There is comedy at times also. It is mostly a redemptive story. Oh – and by the way – you are NOT the protagonist. You are really not even the main character. Truth be told – if you had the ability to read and grasp the entire novel – you would see that you are but one character in a much grander redemptive story that pulls multiple elements together with the ultimate goal of declaring the glory of God.

It is not health and wealth. While the story may have moments of beauty there are a lot of times that it is not pretty. As in most profound novels there are parts of it that are truly painful and tragic. We cannot nor should we trivialize or try to neatly explain those away. The story is gritty and real. It has deep flaws in many of the characters and fractures in many of the events. Parts that could be just perfect are fractured or flawed by the fallen circumstances and characters that make up that chapter. The glory and the beauty comes in how the protagonist – both as the narrator and author – but also as one of the characters in the story – pulls it all together throughout the story and in the end.

God is there.
He created you.
He knows you and loves you.
You are fallen and flawed.
But God is much greater and amazingly He can pull you just as you are through a story – a redemptive story – and bring you to Him. There He can perfect you. And someday – we can sit before Him and in great wonder and love hear the author explain it all so clearly that our hearts will overflow.

That is the world.
It is God’s world.
Please, please, please – don’t miss seeing it!
It happens to be one of my favorite books and I deeply hope you can appreciate it with me.

Can you indeed speculate and dream with me for a moment?

Can you think that your life may indeed be a well written novel? What might have to now looked like scribbles or fragmented story lines, might actually be intricately woven together soon to make wonderful and logical sense. It is not a perfect story. Any good novel does not have perfect characters and perfect actions. There are always twists and turns.

But, as a child on Christmas Eve, can you engage in wonder in the thought that there might indeed be an author for the story that is your life? Can you let the Christmas lights reflect off of your rosy cheeks and glisten in your eyes. Could you look for the author and the story that He is writing as you turn the next pages of your life into the coming year?

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